Aligners and braces for children and teenagers

The American Association of Orthodontists (AAO) recommends that children be screened by an orthodontist by age 7. A screening is not the same as starting treatment: the AAO says treatment may begin then or later, depending on the child. Comprehensive treatment, a full course of braces or clear aligners to straighten the teeth and correct the bite, more often happens in the teenage years. Which appliance suits a teenager depends on the problem and on the teenager: aligners only work if they are worn, while braces stay on but need more care with food and cleaning. An orthodontist who has examined your child makes the clinical decision.

Three different stages

Screening by age 7

By that age, the AAO says, a child has enough permanent teeth for an orthodontist to see a problem that might become larger. Some problems are obvious; others are not. The check includes looking in the mouth, and orthodontists also use panoramic X-rays to look for extra, missing or impacted teeth, or teeth coming through in the wrong place. You do not need a dentist's referral to book.

Early treatment, for selected cases

The AAO says early treatment, while some baby teeth are still present, can guide the growth of the jaws and make space for permanent teeth. It lists problems that may lend themselves to it: underbites, crossbites, a jaw that shifts to one side as the teeth meet, very crowded or very spaced teeth, extra or missing teeth, teeth that meet abnormally or do not meet, and thumb, finger or pacifier sucking that is affecting the teeth or jaw growth.

Invisalign First is one manufacturer's product for what it calls Phase 1 treatment. Its page says it is for children ages 6 to 10, including children who still have some baby teeth. Those ages describe that product, not a rule for every child.

Teenagers

The AAO describes the teen years as a prime window, because permanent teeth are in place and growth can still be guided. It lists metal or ceramic braces, low-profile brackets and clear aligners as options, and says sports, band and social confidence all factor into the choice, along with a hygiene plan. There is no single age at which treatment must start.

Trays or braces for a teenager

Some aligner systems for teens include wear indicators, small blue dots that fade as a tray is worn. A 2011 laboratory study found the dots also fade in water, acidic drinks and cleaning tablets, so they give an estimate of wear, not a measurement.

A school day with each

Aligners. Brush after breakfast and put the trays in. At lunch, trays go into the case, not a napkin; after eating, brush with a travel toothbrush before the trays go back in. For contact sports, trays come out and a mouthguard goes in. Anything other than tap water means trays out. The AAO says your teen should be fine at school the day they get their aligners.

Braces. Pack a lunch without hard, sticky or crunchy foods, or cut food into small pieces. Rinse with water after eating if brushing is not possible. Wear the mouthguard at practice and games. Carry orthodontic wax; the AAO recommends wax and soft or cold foods after adjustments to help with discomfort.

Questions to ask at the consultation

• What problem do you see, and does it need treatment now or monitoring?
• Is early treatment likely to mean a second phase later?
• Would braces or aligners give a better result for this problem, or are both suitable?
• If aligners: how will we know they are being worn, and what happens if they are not?
• How many lost or broken trays are covered, and what does a replacement cost?
• How often are appointments, and can they be outside school hours?
• What does the fee include, including retainers?
• What should we do about sports and music?

What a remote plan cannot replace

The AAO's guidance of December 14, 2023 says an in-person examination and appropriate X-rays are critical before orthodontic treatment.

Growing jaws and teeth that have not yet come through are reasons for a clinician who can see your child, not for a kit.

How clinic and remote treatment differ is in Invisalign and at-home aligners. Which problems aligners are often used for is in what clear aligners can and cannot fix. What to ask about the fee, including insurance and FSA or HSA funds, is in what clear aligners cost in the United States.